Training physicians in particular tasks generally involves “student” physicians working under the close supervision of a treating physician (an “instructor”) as that treating physician deals with and treats patients experiencing particular medical conditions. Drawbacks to this training system are numerous. For instance, students are given limited access to medical conditions, as students can only be exposed to medical conditions that actual patients experience. Further, students generally are not given the latitude to make improper treatment decisions due to the catastrophic conditions that may result.
To provide controlled but realistic training, simulated patients have been developed that can emulate the physiological conditions of a patient experiencing commonly occurring trauma or other medical conditions. For instance, Medical Education Technologies, Inc (“METI”) has developed a computer simulation system consisting of a computer controlled mannequin (a simulated human patient), a physiological monitor, and software used in conjunction with the system. The mannequin and monitor “display” the physiological conditions of a “patient” experiencing a pre-scripted medical condition. The “scripted” medical condition is a software file referred to as a scenario. Each scenario is executed on the computer and specifies: (1) the baseline or starting state of the “patient” experiencing the medical condition; (2) possible stages, or states, of the evolving medical condition. Each “state” within a scenario is composed of (a) physiological events that may occur within the particular state, and (b) possible transitions from one state to another within the scripted medical condition. As the script plays out, the mannequin and monitor will display the physiological conditions and changes specified by the executing scenario.
Transitions can be under instructor control, student control, or system control based upon detection of a change. For instance, the instructor, from a control station, may manually force the script to change states. Alternatively, the script may detect a student response (an “intervention”), for instance, the administration of medication, and automatically change states based upon the intervening action (the medication given/dosage levels, etc.). In this fashion, the METI system allows the evolution of a particular medical condition to be dependent upon decisions made by the student or the instructor. Hence, the same scenario can result in different outcomes based upon the student's responses and interventions.
The METI system accomplishes this by: (1) monitoring variables, such as an intervention detection, and (2) using the variables as inputs to the executing scripted file. The scripted file uses the transition variable's value to make decisions on how the medical condition evolves. Variable values can be automatically determined or set by student actions or the computer system or may be manually input by the instructor from the control station. An example of an automatically determined variable value in the METI system is “lapse of time;” another automatically detected value could be the detection of the administration of electrical shock, detected by sensors placed on the mannequin. Additionally, the instructor can manually modify the ongoing scenario through instructions input through a control station, such as by setting a transition variable value, or forcing the scenario to move to another scripted state (such as through a inputted “go to” type of command).
While flexible in allowing for evolution a single particular physiological event, simulated patient systems, including the METI system, remain cumbersome when used to portray complex medical cases. Many medical conditions or cases reflect more than one physiological event. For instance, an automobile accident trauma patient's overall condition may be the result of internal bleeding, lung collapse, and head injuries. The overall physiological state of the patient may be the result of interactions of the separate physiological events. Further, proper treatment of the overall complex state may progress or sequence differently than would treatment of each physiological event considered alone. To attempt to deal with complex events, some simulations systems, such as the METI system, allows the user to run several scenarios simultaneously. However, each individual scenario runs independently of all other scenarios, and hence, the interaction between scenarios is lacking. What is needed is a method of providing communication between scenarios so that the multiple scenarios can be interwoven into a complete complex case and to provide overall control of the complete case of multiple scenarios by the instructor.